Article Text

PDF
FRI0316 Factors associated with surgical outcomes of severe aortic regurgitation in patients with behcet's disease
  1. B Ghang1,
  2. D-H Lim2,
  3. WJ Seo3,
  4. Y-G Kim1,
  5. B Yoo1
  1. 1Rheumatology, Asan medical center, Seoul
  2. 2Rheumatology, Ulsan University Hospital, Ulsan
  3. 3Rheumatology, Seoul Veterans Hospital, Seoul, Korea, Republic Of

Abstract

Background In rare cases, Behcet's disease (BD) can cause severe aortic regurgitation (AR) or aortic root destruction that might have lethal outcomes. Conventionally, simple aortic valve replacement (AVR) is performed for the management of severe AR in BD patients; however, the reoperation rate is as high as 78 to 100%, while mortality rate range from 20 to 47%. Recently, several series of case reports showed that compared to AVR, aortic root replacement (ARR) improved the surgical outcomes of AR in BD patients.

Objectives To identify the factors associated with the long-term surgical outcomes of AR in BD patients.

Methods We identified 23 patients who had been surgically treated for AR caused by aortic root involvement of BD from January 1996 through December 2013. We evaluated the occurrence of post-surgical adverse events, which were defined as follows: death, aortic valve/graft problem, infective endocarditis, cerebral infarction, and/or re-operation of aortic valve or root. Types of surgery were classified as simple aortic valve replacement (AVR), bioprosthesis aortic root replacement (bARR), and mechanical valved composite graft aortic root replacement (cARR). Clinical parameters including baseline characteristics, C-reactive protein (CRP), erythrocyte sedimentation rate, and medications were extracted from electronic medical records.

Results Appropriate aortic valve or root surgery cases were 35 in total, with a mean follow up duration of 11±5 years in 23 patients. Out of the 11 cases that underwent AVR, post-surgical events were observed in 8 (73%) cases. Out of the 12 bARR cases (xenograft in 5 cases and homograft in 7 cases), 9 (75%) cases had post-surgical adverse events. Out of the 12 cARR cases, post-surgical adverse events occurred in 4 (33%) cases. Multivariable cox proportional hazards model indicated that levels of CRP at 1 month after discharge and age at operation were independent prognostic factors associated with event-free probability. Notably, performing cARR was the most significant factor that affected the surgical outcome (HR (95% CI) 0.147 (0.028 – 0.766), p=0.023).

Conclusions In BD patients with severe AR, the occurrence rate of post-surgical adverse events was associated with the levels of CRP at 1 month after discharge, age at operation, and type of surgery. cARR may be a better surgical option in BD patients with aortic root involvement

References

  1. Jeong DS, Kim KH, Kim JS, Ahn H. Long-term experience of surgical treatment for aortic regurgitation attributable to Behcet's disease. Ann Thorac Surg. 2009;87(6):1775–82.

  2. Song JK, Kim MJ, Kim DH, Song JM, Kang DH, Lee I, et al. Factors determining outcomes of aortic valve surgery in patients with aortic regurgitation due to Behcet's disease: impact of preoperative echocardiographic features. J Am Soc Echocardiogr. 2011;24(9):995–1003.

  3. Liu Q, Ye W, Liu C, Li Y, Zeng R, Ni L. Outcomes of vascular intervention and use of perioperative medications for nonpulmonary aneurysms in Behcet disease. Surgery. 2016;159(5):1422–9.

References

Disclosure of Interest None declared

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.